Online Application Form

Escuela Mexicana Registration Form
Hayde Lopez, Director

Please complete this form and either print and mail to Escuela Mexicana, or copy, paste, and e-mail the completed form to Escuela Mexicana: [email protected]. You may also fill out our Online Registration Form.

Personal Information

Student name:

Roommate name (if applicable):

Address:

City: State/Province: Postal/ZIP code:

Phone: E-mail address:

Birth date: Sex: M F Occupation:

In case of emergency, notify: Phone:

Native language:

Level of Spanish (check one):
______beginning ______intermediate ______advanced ______fluent

How did you hear about Escuela Mexicana?

Classes and Housing

Lodging: arrival date___________ departure date___________

Classes: desired date of first class ___________ date of last class ___________

I would like (check):
______one-on-one tutoring ______group classes
Please note that one-on-one tutoring depends upon availability.

CLASSES

EM 100 "Live" classes (go to stores, restaurants, hotels, banks, bus station, taxi, etc.)
EM 101 Grammar
EM 102 Conversation
EM 103 History
EM 104 Literature
EM 105 Mexican Cooking
EM 106 Dancing

When selecting your classes you may choose one subject for 4 hours or mix and match courses. Each Monday you may choose a new schedule of classes for that week.

1st hour ______________________ 2nd hour ______________________
3rd hour ______________________ 4th hour ______________________

Escuela Mexicana dormitory

I would like (check one):
_______room with private bathroom _________room with shared bathroom

Family homestay

I would like (check all that apply):
________single room ________shared room ________home with children
________non-smoking ________smoking
________child care

Other homestay information (please fill in appropriately):
I will bring a car (check one): ______yes ______no I canât walk further than__________
I have the following dietary restrictions/allergies:_____________________________

Taxi option

I would like to be picked up at the airport through the schoolâs taxi service (check one):
______yes ______no

Date of arrival: Time of arrival: __________ a.m./p.m. (circle one)

Airline: Flight number: Originating city:

Escuela Mexicana
Sostenes Rocha #28, Zona Centro 36000
Guanajuato, Gto. MEXICO
+52(473)732-5005 and +52(473)732-7393
E-mail: [email protected]

Hosted by www.Geocities.ws

Student name:

Roommate name (if applicable):
Address:
City:	State/Province:	Postal/ZIP code:
Phone:	E-mail address:
Birth date:	Sex: M F	Occupation:
In case of emergency, notify:		Phone:
Native language:
Level of Spanish (check one): ______beginning ______intermediate ______advanced ______fluent
How did you hear about Escuela Mexicana?


Lodging: arrival date___________ departure date___________
Classes: desired date of first class ___________ date of last class ___________
I would like (check): ______one-on-one tutoring ______group classes Please note that one-on-one tutoring depends upon availability.
CLASSES EM 100 "Live" classes (go to stores, restaurants, hotels, banks, bus station, taxi, etc.) EM 101 Grammar EM 102 Conversation EM 103 History EM 104 Literature EM 105 Mexican Cooking EM 106 Dancing When selecting your classes you may choose one subject for 4 hours or mix and match courses. Each Monday you may choose a new schedule of classes for that week. 1st hour ______________________ 2nd hour ______________________ 3rd hour ______________________ 4th hour ______________________

I would like (check all that apply): ________single room ________shared room ________home with children ________non-smoking ________smoking ________child care
Other homestay information (please fill in appropriately): I will bring a car (check one): ______yes ______no I canât walk further than__________ I have the following dietary restrictions/allergies:_____________________________

I would like to be picked up at the airport through the schoolâs taxi service (check one): ______yes ______no
Date of arrival:	Time of arrival: __________ a.m./p.m. (circle one)
Airline:	Flight number:	Originating city: